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        <h1>
            HIV infection</h1>
        <h5 class="updated">
            Last updated: Monday, 13, December, 2010</h5>
        <table cellpadding="0" cellspacing="0" class="two-column-process">
            <thead>
                <tr>
                    <th>
                        Key Information</th>
                    <th class="description">
                        Appropriate Tests</th>
                </tr>
            </thead>
            <tr class="odd">
                <td class="first">
                    <strong>Diagnosis</strong></td>
                <td class="second">
                    <p>
                        <b>HIV antibodies/antigen combination assay</b>, with consent and after 
                        counselling.</p>
                    <p>
                        A positive test should be repeated on a further specimen for confirmation.</p>
                    <p>
                        A negative test does not exclude infection.</p>
                    <p>
                        Seroconversion usually occurs within 1 month but may be delayed up to 3 months, 
                        even following a high risk exposure.</p>
                    <p>
                        HIV antigen (p24) has only limited sensitivity; <b>HIV-1 RNA (viral load)</b> 
                        may be of use during this &#39;window period&#39;.</p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <strong>Initial assessment</strong></td>
                <td class="second">
                    <b>FBC; lymphocyte typing (absolute CD4, CD8 counts); syphilis serology; 
                    hepatitis B virus testing, hepatitis C virus testing, cytomegalovirus 
                    antibodies, toxoplasma antibodies, HIV-1 antigen, HIV RNA (viral load).</b></td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <strong>Monitoring</strong></td>
                <td class="second">
                    <p>
                        <b>FBC; lymphocyte typing - CD4 and CD8 levels</b> indicate degree of 
                        immunosuppression.</p>
                    <p>
                        <b>HIV-1 RNA</b> provides a measure of viral load and is particularly useful in 
                        following the response to therapy.</p>
                    <p>
                        Beta-2-microglobulin is of limited value HIV drug resistance studies.</p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <strong>Criteria for HIV infection</strong></td>
                <td class="second">
                    Either repeatedly positive tests for HIV antibody supported by a positive 
                    confirmatory test or direct identification of HIV by virus isolation.</td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <strong>CDC classification (original)</strong></td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Group I</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li>Acute mononucleosis syndrome</li>
                    </ul>
                </td>
                <td class="second">
                    See under&nbsp;<a 
                        href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=416&amp;Itemid=27" 
                        target="_blank">Lymphocytosis</a></td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Group II</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li>Asymptomatic infection</li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Group III</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li>Persistent generalised lymphadenopathy</li>
                    </ul>
                </td>
                <td class="second">
                    See
                    <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=414&amp;Itemid=27" 
                        target="_blank">Lymphadenopathy</a></td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Group IV</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li>AIDS and &#39;AIDS related complex&#39;</li>
                    </ul>
                </td>
                <td class="second">
                    See Category C below and&nbsp;<a 
                        href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=41&amp;Itemid=27" 
                        target="_blank">AIDS</a></td>
            </tr>
            <tr>
                <td class="first">
                    <strong>CDC staging system (1993)</strong></td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    Category A
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <ul>
                        <li>Acute seroconversion illness</li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li>Asymptomatic patients</li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <ul>
                        <li>Progressive generalised lymphadenopathy</li>
                    </ul>
                </td>
                <td class="second">
                    See
                    <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=414&amp;Itemid=27" 
                        target="_blank">Lymphadenopathy</a></td>
            </tr>
            <tr class="odd">
                <td class="first">
                    Category B</td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Symptomatic HIV disease</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li>Bacillary angiomatosis</li>
                    </ul>
                </td>
                <td class="second">
                    Cat scratch disease antibodies.</td>
            </tr>
            <tr>
                <td class="first">
                    <ul>
                        <li>Vaginal Candidiasis</li>
                    </ul>
                </td>
                <td class="second">
                    Persistent or poorly responsive to therapy. See
                    <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=100&amp;Itemid=27" 
                        target="_blank">Candidiasis</a></td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li>Oral Candidiasis</li>
                    </ul>
                </td>
                <td class="second">
                    See
                    <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=100&amp;Itemid=27" 
                        target="_blank">Candidiasis</a></td>
            </tr>
            <tr>
                <td class="first">
                    <ul>
                        <li>Cervical dysplasia</li>
                    </ul>
                </td>
                <td class="second">
                    See&nbsp;<a 
                        href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=113&amp;Itemid=27" 
                        target="_blank">Cervical lesion</a></td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li>Cervical carcinoma <em>in-situ</em></li>
                    </ul>
                </td>
                <td class="second">
                    See&nbsp;<a 
                        href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=113&amp;Itemid=27" 
                        target="_blank">Cervical lesion</a></td>
            </tr>
            <tr>
                <td class="first">
                    <ul>
                        <li>Constitutional symptoms</li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li>Fever &gt;38.5ºC</li>
                    </ul>
                </td>
                <td class="second">
                    See&nbsp;<a 
                        href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=511&amp;Itemid=27" 
                        target="_blank">Pyrexia of unknown origin</a></td>
            </tr>
            <tr>
                <td class="first">
                    <ul>
                        <li>Diarrhoea &gt;1 month</li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li>Oral hairy leukoplakia</li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <ul>
                        <li>Herpes zoster infection</li>
                    </ul>
                </td>
                <td class="second">
                    <p>
                        On two occasions or involving more than one dermatome.</p>
                    <p>
                        See&nbsp;<a 
                            href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=574&amp;Itemid=27" 
                            target="_blank">Varicella zoster infection</a></p>
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li>Immune thrombocytopenia</li>
                    </ul>
                </td>
                <td class="second">
                    FBC; platelet antibodies. See
                    <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=739&amp;Itemid=27" 
                        target="_blank">Thrombocytopenia</a></td>
            </tr>
            <tr>
                <td class="first">
                    <ul>
                        <li><a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=406&amp;Itemid=27" 
                                target="_blank">Listeriosis</a></li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li>Pelvic inflammatory disease</li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <ul>
                        <li>Peripheral neuropathy</li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    Category C</td>
                <td class="second">
                    See&nbsp;<a 
                        href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=41&amp;Itemid=27" 
                        target="_blank">AIDS</a>&nbsp;for listing of AIDS defining illnesses.</td>
            </tr>
            <tr>
                <td class="first">
                    <strong>AIDS surveillance case definition</strong></td>
                <td class="second">
                    Basis for notification of AIDS.</td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        CD4 count &lt;0.2 x 109/L</p>
                </td>
                <td class="second">
                    This criterion is used by the CDC but has not been adopted in Australasia.</td>
            </tr>
            <tr class="last">
                <td class="first">
                    <p>
                        Category C patients</p>
                </td>
                <td class="second">
                    <p>
                        Any patient with HIV infection and an AIDS defining illness is included in the 
                        Australasian AIDS surveillance case definition.</p>
                    <p>
                        See&nbsp;<a 
                            href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=41&amp;Itemid=27" 
                            target="_blank">AIDS</a></p>
                </td>
            </tr>
        </table>
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            <h2>
                Glossary Terms</h2>
            <div>
                <h4>
                    AIDS:</h4>
                <p>
                    Acquired immunodeficiency syndrome</p>
                <h4>
                    CDC :</h4>
                <p>
                    Centre for Disease Control</p>
                <h4>
                    FBC :</h4>
                <p>
                    Full blood count , full blood examination, complete blood count</p>
                <h4>
                    HIV :</h4>
                <p>
                    Human&nbsp;immunodeficiency&nbsp;virus</p>
                <h4>
                    RNA :</h4>
                <p>
                    Ribonucleic acid</p>
            </div>
        </div>
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            The RCPA wishes to acknowledge the Australian Government Department of Health 
            and Ageing for their generous support of the RCPA Manual.<br />
            ISSN 1449-8219</p>
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